DeVault Otologic Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis.
Department of Psychological and Brain Sciences, Indiana University Bloomington.
Am J Audiol. 2022 Sep;31(3):552-566. doi: 10.1044/2022_AJA-21-00261. Epub 2022 Aug 9.
Individual differences and variability in outcomes following cochlear implantation (CI) in patients with hearing loss remain significant unresolved clinical problems. Case reports of specific individuals allow for detailed examination of the information processing mechanisms underlying variability in outcomes. Two adults who displayed exceptionally good postoperative CI outcomes shortly after activation were administered a novel battery of auditory, speech recognition, and neurocognitive processing tests.
A case study of two adult CI recipients with postlingually acquired hearing loss who displayed excellent postoperative speech recognition scores within 3 months of initial activation. Preoperative City University of New York sentence testing and a postoperative battery of sensitive speech recognition tests were combined with auditory and visual neurocognitive information processing tests to uncover their strengths, weaknesses, and milestones.
Preactivation CUNY auditory-only (A) scores were < 5% correct while the auditory + visual (A + V) scores were > 74%. Acoustically with their CIs, both participants' scores on speech recognition, environmental sound identification and speech in noise tests exceeded average CI users scores by 1-2 standard deviations. On nonacoustic visual measures of language and neurocognitive functioning, both participants achieved above average scores compared with normal hearing adults in vocabulary knowledge, rapid phonological coding of visually presented words and nonwords, verbal working memory, and executive functioning.
Measures of multisensory (A + V) speech recognition and visual neurocognitive functioning were associated with excellent speech recognition outcomes in two postlingual adult CI recipients. These neurocognitive information processing domains may underlie the exceptional speech recognition performance of these two patients and offer new directions for research explaining variability in postimplant outcomes. Results further suggest that current clinical outcome measures should be expanded beyond the conventional speech recognition measures to include more sensitive robust tests of speech recognition as well as neurocognitive measures of working memory, vocabulary, lexical access, and executive functioning.
在听力损失患者中，耳蜗植入（CI）后的个体差异和结果变异性仍然是未解决的临床问题。特定个体的病例报告允许对导致结果变异性的信息处理机制进行详细检查。两名在激活后不久表现出异常良好的术后 CI 结果的成年人接受了一系列新的听觉、语音识别和神经认知处理测试。
对两名成人 CI 接受者进行案例研究，他们因后天获得性听力损失而接受 CI，在初始激活后 3 个月内显示出出色的术后语音识别得分。在术前进行纽约城市大学句子测试，并在术后进行一系列敏感的语音识别测试，结合听觉和视觉神经认知信息处理测试，以发现他们的优势、劣势和里程碑。
在激活前，CUNY 纯听觉（A）得分低于 5%，而听觉+视觉（A+V）得分高于 74%。在声学方面，这两名参与者的语音识别、环境声音识别和语音噪声测试得分都超过了平均 CI 用户得分 1-2 个标准差。在语言和神经认知功能的非声学视觉测量方面，两名参与者在词汇知识、视觉呈现单词和非单词的快速语音编码、言语工作记忆和执行功能方面的得分均高于正常听力成年人的平均水平。
多感官（A+V）语音识别和视觉神经认知功能的测量与两名后天性成人 CI 接受者的出色语音识别结果相关。这些神经认知信息处理领域可能是这两名患者异常语音识别表现的基础，并为解释术后结果变异性提供了新的研究方向。结果进一步表明，目前的临床结果测量应该从传统的语音识别测量扩展到更敏感的语音识别测试以及言语工作记忆、词汇量、词汇访问和执行功能等神经认知测试。
